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Monthly Archives: February 2020

In my first job I traveled a lot between world capitals, often spending weeks at a time on an airplane supporting senior government officials and their teams. One of them was an especially interesting guy, extensive experience in business, politics, and government, and had a set of “rules” he would would give out. They really weren’t rules per se, but a collection of quotations and reflections based on his experiences, some funny, some thoughtful, that covered working in the White House and government, business, and how to stay sane in life in general. As a young officer I found them very valuable – I still have my signed copy. Later on he became (in)famous for saying ..

…because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don’t know we don’t know. And if one looks throughout the history of our country and other free countries, it is the latter category that tend to be the difficult ones.

That is a restatement of something developed in the mid 1950’s known as the Johari Window. As a concept it’s been around for a while, especially in the intelligence and aerospace communities. The basic idea is that the things that you don’t know you don’t know are the ones that have the potential to cause you the most trouble. It’s a useful tool for assessing information and decision making. Recently several sociologists have suggested adding another category: things we do know, but don’t believe for one reason or another. And I think that is the most dangerous category of all, and what we are facing at this moment in several areas such as with this virus. People are thinking and acting like some information is unknown, when it is in fact known – but for various reasons don’t want to believe it.

Yesterday morning the US Centers for Disease Control (CDC) gave a media briefing, led by Dr. Nancy Messonnier, Director of the National Center for Immunization and Respiratory Diseases. The transcript still isn’t up, but you can listen to the audio here if you have 30 minutes. After it was over, I was thinking “OK, nothing here to get excited over, not really any new data.” Then the news reports started coming out and I started getting messages, headlines like this NBC article: “Americans should prepare for coronavirus crisis in U.S, CDC Says” and pull quotes like “It’s not so much a question of if this will happen anymore but rather more a question of exactly when,” an official said. I thought “wow, did I miss something?” so I listened again. Nope. So what’s going on? Is it time to panic, get masks, and start drinking?

Maybe not. Let’s start with the pull quote. What Dr. Messonnier said in full was “It’s not so much a question of if this will happen anymore but rather more a question of exactly when this will happen and how many people in this country will have severe illness.” In my view that puts a whole different spin on things – the “how many people will have severe illness” is the key. Certainly we should prepare – especially health care providers need to dust off their pandemic response plans (and, recall that Pandemic doesn’t mean people dropping dead in the streets, all it means is widespread). Schools and businesses should probably think about what they would do if – and at this point, it’s a very big if with decreasing probability – things get bad. Check ready.gov for some good advice and checklists. Most of these things are stuff you should have already done to prepare for earthquakes, hurricanes, etc.

This points up a huge problem with how complex, scientific topics are covered by the media. The details matter. You can’t just grab a pull quote (and especially cut off the quote halfway for a headline!) and covey the nuance people need. It stokes fear and uncertainty – and that has consequences. Just look at what the stock markets are doing (some of which is justified because of Chinese supply chain disruptions, but risk taking on a life of their own).

Please be careful of other sources – even the major media (and especially bloggers – yes, even well connected and informed sites like this one) – and be careful of how CDC data is interpreted. Determining risk in a dynamic situation like this is tricky. For example … from the New York Times today:

Experts have said that, based on the number of dead, the total number of cases in Iran is probably much higher, as the illness linked to the virus appears to kill about one of every 50 people infected.

I’d be really interested in hearing exactly what was said to the reporter(s). There is no doubt that with 14 deaths, based on what we know, there would be a lot of infections. But the statement that “the virus appears to kill about one of every 50 people infected” is extremely misleading. A more accurate statement is that it appears to kill about one in 50 people who were able or sick enough to seek medical care andwerediagnosed as having COVID-19. The present state of understanding of COVID-19 (as of Monday, 24 Feb 2020) is that it seems like a lot of people get infected and don’t need to seek out medical care. There is also uncertainty in the mortality in that especially in China it is likely deaths are under-reported. But using the data from outside China, 1 in 50 of people who were sick enough to be checked seems reasonable. So what does than mean? Let’s say that conservatively only 1 in 2 people seek care – the other half think they just had normal flu or a cold. That would make the rate 1 in 100 (1 percent). But the likely number is more like only 1 in 10 people get sick enough to seek medical care. That makes the rate 0.2 percent. So you can see how sensitive the numbers are to figuring out how many people were actually exposed, and then got sick.

Like this:

Over the weekend there have been some major, and on the surface rather frightening developments surrounding the corornavirus outbreak that started in China last year. So how bad is it, and should you be freaking out? When the media starts using words like “pandemic” people start to panic. But the bottom line on this situation is there is more reason to worry about the panic than the pandemic. Here’s some perspective:

CDC/ Alissa Eckert, MS; Dan Higgins, MAM – This media comes from the Centers for Disease Control and Prevention’s Public Health Image Library (PHIL), with identification number #23312.

Part of the problem is that the info coming out of China is pretty obviously crap. We just don’t have a good picture of things like how contagious it is, and in particular nobody really believes the statistics on the number of cases and associated mortality rate. That has given rise to lots of crazy rumors and fear mongering. But it seems like the following is true of COVID-19, based on reliable sources: Continue reading →